Abstract
ABSTRACTPurposeTo compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi.Materials and MethodsThe medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared.ResultsThere was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2.ConclusionOur study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.
Highlights
Extracorporeal shock wave lithotripsy (ESWL) and flexible ureteroscopic stone removal are widely used modalities for renal stones, percutaneous nephrolithotomy (PCNL) is still needed for selected cases ibju | Percutaneous nephrolithotomy complications according to the size, position, shape, and composition of the stones [3]
PCNL is recommended for cases with stones larger than 20mm2, cases with struvite or cystine stones, cases in which stone removal failed with extracorporeal shock wave lithotripsy (ESWL), or cases accompanied by anatomical malformation [5, 13]
We observed that when the approach in Group 2 was not from the incision site, the dilation was easy compared to access gained from the region of scar tissue
Summary
Since the first report of the removal of renal stones via nephrostomy by Rupel and Brown in 1941 [1], there have been significant improvements in techniques, instruments, and experience. Extracorporeal shock wave lithotripsy (ESWL) and flexible ureteroscopic stone removal are widely used modalities for renal stones, PCNL is still needed for selected cases ibju | Percutaneous nephrolithotomy complications according to the size, position, shape, and composition of the stones [3]. Open stone surgery has been replaced by PCNL because of its cost effectiveness, lower morbidity, shorter operative time and lower postoperative complications [5, 6]. Some patients with history of open stone surgery need PCNL because of renal stone recurrences [7, 8]. PCNL or open stone surgery causes scar tissue and anatomical modifications in kidney that may affect later PCNL. PCNL does carry a risk of significant morbidity, with contemporary series describing a complication rate of 20.5% [14]
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